Sensitivity analysis for publication bias on the time-dependent summary ROC analysis in meta-analysis of prognosis studies

In the analysis of prognosis studies with time-to-event outcomes, dichotomization of patients is often made. As the evaluations of prognostic capacity, the survivals of groups with high/low expression of the biomarker are often estimated by the Kaplan-Meier method, and the difference between groups is summarized via the hazard ratio (HR). The high/low expressions are usually determined by study-specific cutoff values, which brings heterogeneity over multiple prognosis studies and difficulty to synthesizing the results in a simple way. In meta-analysis of diagnostic studies with binary outcomes, the summary receiver operating characteristics (SROC) analysis provides a useful cutoff-free summary over studies. Recently, this methodology has been extended to the time-dependent SROC analysis for time-to-event outcomes in meta-analysis of prognosis studies. In this paper, we propose a sensitivity analysis method for evaluating the impact of publication bias on the time-dependent SROC analysis. Our proposal extends the recently introduced sensitivity analysis method for meta-analysis of diagnostic studies based on the bivariate normal model on sensitivity and specificity pairs. To model the selective publication process specific to prognosis studies, we introduce a trivariate model on the time-dependent sensitivity and specificity and the log-transformed HR. Based on the proved asymptotic property of the trivariate model, we introduce a likelihood based sensitivity analysis method based on the conditional likelihood constrained by the expected proportion of published studies. We illustrate the proposed sensitivity analysis method through the meta-analysis of Ki67 for breast cancer. Simulation studies are conducted to evaluate the performance of the proposed method.